9 Secrets of Coroners and Medical Examiners

Many true crime aficionados are familiar with the popular portrayal of coroners and medical examiners and their daily interaction with the dead. In the real world, their essential task—confirming a death and figuring out what caused it—is far more involved than what you see on television. Mental_floss spoke with Graham Hetrick, coroner for Dauphin County, Pennsylvania and star of Investigation Discovery’s show The Coroner: I Speak for the Dead, as well as several other medical examiners, to get some insights about their work on the autopsy table and elsewhere.

1. THERE CAN BE A BIG DIFFERENCE BETWEEN MEDICAL EXAMINERS AND CORONERS.

The coroner system dates to medieval England, when these officials, then called crowners, worked for the king investigating frauds, thefts, and deaths. These days, a coroner’s main duties are to confirm and certify a death, and to determine whether an investigation is warranted. Prerequisites for coroners vary widely from state to state, with some states requiring that they be certified pathologists while others allow jurisdictions to elect laypeople to the position. Other states, particularly those with large urban centers, have adopted systems employing medical examiners—who are always physicians, never laypeople.

But while coroners in a few jurisdictions may hold little more than a high school diploma, many are highly qualified professionals. Hetrick has a particularly varied background. He is also a medical legal death investigator (an expert in examining the manner and cause of death), thanatologist (a specialist in the scientific study of death), forensics consultant, and funeral director, with advanced training in blood pattern analysis, crime scene management, and forensic sculpting. Hetrick says that while Pennsylvania employs mainly coroners, his system is a hybrid one in which he works closely with a forensic pathologist.

2. MEDICAL EXAMINERS ARE DOCTORS—BUT FOR THE DEAD.

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Bruce Goldfarb, executive assistant to Baltimore’s chief medical examiner, explains that while all of the doctors in his department are board-certified forensic pathologists, other cities have had medical examiners who are obstetricians or dentists. But no matter what, Goldfarb says, medical examiners are still “doctors doing doctor work. When we go to the doctor, they do a physical exam, maybe send you for a chest x-ray, order a urinalysis or blood tests, and then they figure out what, if anything, is wrong with you. Our doctors do the same thing, except the patient is dead and they're trying to figure out why.” Unlike regular doctors, however, medical examiners don’t generally have to deal with medical insurance or malpractice suits.

3. THEY MAY NEED TO CALL IN A BOTANIST.

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Coroners and medical examiners collaborate closely with other experts, including forensic photographers, toxicologists, forensic anthropologists, and odontologists (dental experts). Hetrick compares his role as a coroner to that of an orchestra conductor, overseeing different instruments coming together to play “the music of the dead.” He notes that specialists from fields that might seem unrelated to his work—such as entomologists and botanists—can be very helpful in determining time of death based on the life forms that have taken root in a corpse. He describes one case, profiled in episode 4 of The Coroner, in which he called in a botanist to examine a plant growing through the eye socket of a skull in order to pinpoint how long the body had been in that spot.

4. THEY ADVOCATE FOR THE DEAD.

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When most people think of advocacy, they think of efforts to protect the rights of disenfranchised populations among the living. But people who have died under mysterious circumstances or as a result of violence need advocates too. Dr. Marianne Hamel, a New Jersey-based medical examiner and one of the creators of the project Death Under Glass, says of her work: “It helps to look at the job as advocacy for the dead—they are, in many ways, the most disenfranchised among us. They can't testify for themselves or directly tell a jury the story of their suffering. That’s the job of a forensic pathologist.”

Hetrick expands on this outlook, seeing it as his duty to listen to the stories that the dead tell through their physical presence, including damage and decay to their bodies and their position in a crime scene. “I am a storyteller,” he says, “but they are not my stories.”

5. THEY HAVE TO BE VERY CAREFUL AT A CRIME SCENE.

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In addition to being connected to a wide array of forensic and other sciences, the work of coroners and medical investigators is closely tied to legal investigations into specific deaths. Hetrick stresses that forensics is “science applied to law,” meaning that all physical evidence uncovered during a forensic investigation must hold up in court. “Otherwise,” he says, “it’s just opinion.”

In order for evidence gathered during a coroner’s or medical examiner’s investigation to hold up in court, the investigators must be thoroughly familiar with crime scene procedure and follow chain of evidence practices. Chain of evidence refers to proper collection and processing of crime scene evidence, including thorough, continuous documentation of who handled the evidence and when. Hetrick says that failure to correctly document handling of evidence affected the outcome of the O. J. Simpson case, making it impossible to convict Simpson in criminal court.

6. THEY ARE SLEUTHS.

The job of a coroner or medical examiner demands endless curiosity and a desire to extract the truth from every case. This process can take years, and many of these professionals describe being haunted by cold cases that were never solved. Naturally, persistence and a strong problem-solving aptitude are desirable attributes. Goldfarb says one of the most challenging types of cases is also one of the most common—somebody “found dead at home, no obvious injuries, no signs of foul play. ... It could be anything; drug intoxication, heart attack/stroke, head injury ... could be suicide, could be accident, could be homicide. Every possibility has to be considered and run down.” Hamel adds that cases are not always what they seem at first, and that she may encounter a natural death that turns out to be a drug overdose, or a suicidal hanging that is actually an autoerotic asphyxiation.

7. THEY ARE NOT ALWAYS PORTRAYED ACCURATELY ON TELEVISION.

Hetrick says Investigation Discovery’s show captures many important aspects of his profession, particularly the science behind it and the interactions of coroners with the rest of the investigation. Fictional portrayals of coroners and medical investigators, however, are not always so accurate. Hetrick says the typical television pathologist, laboring in a laboratory in isolation, often strikes him as “kind of disturbed.” Goldfarb says that in real life, investigations usually do not wrap up as quickly as they seem to on television. Plus, homicides—which represent about 4 to 5 percent of the cases the Baltimore OCME investigates—are overrepresented.

Hamel agrees that television is prone to bend the truth in the name of drama. “I don’t carry a gun, I've never interrogated a live suspect, and,” she says, “I don't perform autopsies in the middle of the night under a single, bare, swinging light bulb.”

8. THEY WORK WITH THE LIVING, TOO.

In addition to their interactions with law enforcement and forensics specialists, a big part of coroners’ and medical examiners’ jobs entails communicating with grieving family members. Hamel emphasizes the need to remain even-tempered and compassionate toward family members who may become understandably overwrought or angry. Goldfarb, who has a background in psychiatry and crisis intervention, concurs. “One of the challenges of the job is constantly keeping in mind that for me this is an ordinary Monday, but the people I speak with on the phone are having one of the worst days of their life,” he says.

Hamel adds that, contrary to the stereotype of the shy, solitary forensic pathologist, people in her field are often called on to testify before a jury or to lecture death investigators or police trainees—so it helps to be outgoing.

9. DEATH INFORMS THEIR OUTLOOK ON LIFE.

Hetrick emphasizes that one of the main differences between The Coroner: I Speak for the Dead and other forensic investigation shows is its emphasis on what the dead have to teach the living. “The reason I’m doing the show,” he says, “is because of what the dead show us about how we live and how we should live.” For Hetrick, this means examining both the psychology of those who commit murders and what their actions say about society, as well as the impact that deaths have on living people. He describes his interactions with the family of the victim portrayed in the show’s first episode—a woman named Iris who was killed while trying to build a better life for herself—as emotional, but says it was gratifying to see Iris’s daughter motivated to pursue her dreams in part because of the untimely death of her mother.

On a more personal level, Hetrick says the constant exposure to death prompts him to constantly reevaluate his own life, and to avoid taking anything for granted. “It’s a very thin line [between life and death], believe me,” he says. “A lot of people on that autopsy table thought today was just another day.”